Healthcare Provider Details

I. General information

NPI: 1053768127
Provider Name (Legal Business Name): HAWAII PELVIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 BISHOP ST STE 910
HONOLULU HI
96813-3304
US

IV. Provider business mailing address

525 ULUKOU ST
KAILUA HI
96734-4427
US

V. Phone/Fax

Practice location:
  • Phone: 808-990-9011
  • Fax:
Mailing address:
  • Phone: 808-990-9011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number8004
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3328
License Number StateHI

VIII. Authorized Official

Name: MRS. DEBORAH WEBER
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 808-990-9011